| NPI | 1558073833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 13063) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 134735) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-09-18 |